GOMA, Congo — It's said that 5 million people have died due to conflict in Congo over the past decade. If that beggars belief, consider the family of 18-year-old Florence Nirere.

Sixteen months ago in Nirere's hillside village in eastern Congo, rebel fighters clashed with government troops and sent civilians fleeing. A Congolese soldier shot her cousin, a pretty 25-year-old named Nirabundu, in the head because she didn't run from the battlefield fast enough, Nirere said.

Now the family lives in a camp for eastern Congo's growing legion of displaced people, a sprawling collection of canvas-covered shacks where hunger and disease are the worst killers. This month Nirere helped bury an older sister who fell ill from malnutrition. Two days later, her 6-year-old, diarrhea-stricken brother, Habi, lay in a cot in the local clinic, his toothpick arms pierced by tubes pumping nutrients into his motionless body.

"We are dying," Nirere, who has close-cropped hair and stoic, wide-set eyes, said simply.

The International Rescue Committee, a New York-based relief agency, says that although 45,000 are people dying every month — a mortality rate that's 60 percent higher than Africa's average — Congo remains a "forgotten crisis."

The vast country, ruggedly beautiful and mineral-rich, has been a crucible of suffering for years, with the death toll from a civil war and the ensuing humanitarian crisis estimated to be the greatest of any conflict since World War II. Now a new round of fighting between government soldiers and the well-equipped army of a renegade general, Laurent Nkunda, is threatening the lives of hundreds of thousands more civilians in eastern Congo, the epicenter of the crisis.

Over the past two months, the fighting — which has its roots in the 1994 genocide in neighboring Rwanda — has killed at least 100 civilians and forced 250,000 from their homes, according to Human Rights Watch. As a cease-fire between Nkunda's forces and the government nears collapse, aid workers say that civilians are at risk not just of getting caught in the crossfire but also of being attacked, raped or killed by soldiers on both sides.

"These populations are living with great fear of rebels and other belligerents coming into the camps," said Kevin Cook, a spokesman for the relief agency World Vision. "The conditions are about as bad as they could be."

Relief agencies are struggling to reach people who've spread out for safety over a forbidding landscape, many lacking food, water and shelter from the epic equatorial rains.

Around midday Friday in Kibati, where Nirere lives alongside more than 50,000 other displaced people outside the town of Goma, the sound of heavy artillery rang out from the north. U.N. peacekeepers said that a handful of Nkunda's men were descending a hillside and fired guns into the air, prompting Congolese soldiers to respond with mortar rounds and machine-gun fire.

The skirmish was over within a half-hour, but hundreds of people who'd lined up for an emergency handout of maize, beans, cooking oil and soap immediately scattered in panic, said Marcus Prior, a spokesman for the U.N. World Food Program, which organized the distribution.

Eastern Congo has been at the mercy of armed groups for more than a decade, since the end of the Rwandan genocide, when remnants of the Hutu militias that slaughtered some 800,000 Tutsis fled across the border into what was then called Zaire. Nkunda launched his rebellion in large part to protect his Tutsi community from attacks by Hutus, although human rights groups say that as his ambitions have grown his army increasingly has been attacking civilians.

In 2006 Congo chose Joseph Kabila as its first democratically elected president in more than four decades. However, the weaknesses of Kabila's government are epitomized by the Congolese army, an ill-paid conglomeration of onetime militias that are "prone to abandoning their posts and capitalizing on the chaos to loot and terrorize the population," the relief group Refugees International wrote in a report this week.

Nkunda, a reedy man with a messianic streak, is unapologetic about the violence, which he says is necessary to liberate Congo from Kabila's corrupt government.

"That is the cost of freedom," Nkunda said earlier this week in the mountaintop town of Kitchanga, now controlled by his forces. "You have to suffer sometimes (to) be free forever."

The suffering among civilians, however, is worsening. In North Kivu province, which includes Goma, one in six people have been forced from their homes, the U.N. says. Most find their way to camps such as the one in Kibati, where malaria, diarrhea and other maladies are rife, and insecurity often hinders deliveries of food aid.

Some in Kibati have taken to stealing unripe, lime-green bananas from the fields adjacent to the camp. Farmers often chase after the thieves brandishing machetes, leading people in the camp to nickname them "Interahamwe," after the militias that carried out the Rwandan genocide, because the machete was their weapon of choice.

The world's largest U.N. peacekeeping force — some 17,000 soldiers — is badly overmatched in the enormous region. In North Kivu, there's roughly one peacekeeper for every three square miles, while in some places Nkunda's forces and government troops are separated by only about 500 yards, U.N. military officials say.

"Any small incident can be the beginning of a new offensive," said Lt. Col. Jean-Paul Dietrich, a U.N. military spokesman. "In this respect we are completely overstretched."

Analysts say that the peacekeepers are in an impossible position, forced under a recent agreement to monitor buffer zones between the Congolese army and Nkunda's forces as well as provide logistical support to the Congolese.

Many civilians have turned on the U.N., accusing it of being in league with the hated army. Last month, mobs of angry Congolese pelted rocks at U.N. compounds in Goma, and over the past year many peacekeepers have been outfitted with plexiglass face masks for their helmets.

"They are the ones who bring the war," Nirere said of the peacekeepers, as others gathered around her grunted in agreement. "But the government is worse. They are only killing us."

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